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OBJECTIVES: Obesity and its sequelae are an increasing problem, disproportionally affecting Maori and Pacific peoples, secondary to multifactorial systemic causes, including the effects of colonisation and the impact of globalisation. There is limited synthesised evidence on interventions to address obesity in these populations. The objective of this review is to identify evaluated interventions for prevention and management of obesity amongst Maori and Pacific adults, assess the effectiveness of these interventions, and identify enablers and barriers to their uptake. DESIGN: Systematic review of databases (Medline, PubMed, EMBASE, CINAHL, Scopus, CENTRAL), key non-indexed journals, and reference lists of included articles were searched from inception to June 2021. Eligibility criteria defined using a Population, Intervention, Control, Outcome format and study/publication characteristics. Quantitative and qualitative data were extracted and analysed using narrative syntheses. Study quality was assessed using modified GRADE approach. RESULTS: From the 8190 articles identified, 21 were included, with 18 eligible for quantitative and five for qualitative analysis. The studies were heterogenous, with most graded as low quality. Some studies reported small but statistically significant improvements in weight and body mass index. Key enablers identified were social connection, making achievable sustainable lifestyle changes, culturally-centred interventions and incentives including money and enjoyment. Barriers to intervention uptake included difficulty in maintaining adherence to a programme due to intrinsic programme factors such as lack of social support and malfunctioning or lost equipment. CONCLUSIONS: Normal weight trajectory is progressive increase over time. Modest weight loss or no weight gain after several years may have a positive outcome in lowering progression to diabetes, or improvement of glycaemic control in people with diabetes. We recommend urgent implementation of Maori and Pacific-led, culturally-tailored weight loss programmes that promote holistic, small and sustainable lifestyle changes delivered in socially appropriate contexts.
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Assistência à Saúde Culturalmente Competente , Povo Maori , Obesidade , Programas de Redução de Peso , Adulto , Humanos , Povo Maori/estatística & dados numéricos , Obesidade/epidemiologia , Obesidade/prevenção & controle , Obesidade/terapia , População das Ilhas do Pacífico/estatística & dados numéricos , Apoio Social , Assistência à Saúde Culturalmente Competente/métodos , Estilo de Vida Saudável , Programas de Redução de Peso/métodos , Competência CulturalRESUMO
OBJECTIVE: To test the feasibility of a browser extension to estimate the exposure of adolescents to (un)healthy food and beverage advertisements on Facebook and the persuasive techniques used to market these foods and beverages. DESIGN: A Chrome browser extension (AdHealth) was developed to automatically collect advertisements seen by participants on their personal Facebook accounts. Information was extracted and sent to a web server by parsing the Document Object Model tree representation of Facebook web pages. Key information retrieved included the advertisement type seen and duration of each ad sighting. The WHO-Europe Nutrient Profile Model was used to classify the healthiness of products advertised as permitted (healthy) or not permitted (unhealthy) to be advertised to children. SETTING: Auckland, New Zealand. PARTICIPANTS: Thirty-four Facebook users aged 16-18 years. RESULTS: The browser extension retrieved 4973 advertisements from thirty-four participants, of which 204 (4 %) were food-related, accounting for 1·1 % of the exposure duration. Of those food advertisements, 98 % were classified as not permitted, and 33·7 and 31·9 %, respectively, of those featured promotional characters or premium offers. The mean rate of exposure to not permitted food was 4·8 (sd = 2·5) advertisements per hour spent on Facebook. CONCLUSIONS: Using a Chrome extension to monitor exposure to unhealthy food and beverage advertisements showed that the vast majority of advertisements were for unhealthy products, despite numerous challenges to implementation. Further efforts are needed to develop tools for use across other social media platforms and mobile devices, and policies to protect young people from digital food advertising.
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Indústria Alimentícia , Marketing , Mídias Sociais , Adolescente , Bebidas , Criança , Europa (Continente) , Estudos de Viabilidade , Alimentos , Humanos , Nova Zelândia , TelevisãoRESUMO
Globally type 1 diabetes incidence is increasing. It is widely accepted that the pathophysiology of type 1 diabetes is influenced by environmental factors in people with specific human leukocyte antigen haplotypes. We propose that a complex interplay between dietary triggers, permissive gut factors and potentially other influencing factors underpins disease progression. We present evidence that A1 ß-casein cows' milk protein is a primary causal trigger of type 1 diabetes in individuals with genetic risk factors. Permissive gut factors (for example, aberrant mucosal immunity), intervene by impacting the gut's environment and the mucosal barrier. Various influencing factors (for example, breastfeeding duration, exposure to other dietary triggers and vitamin D) modify the impact of triggers and permissive gut factors on disease. The power of the dominant trigger and permissive gut factors on disease is influenced by timing, magnitude and/or duration of exposure. Within this framework, removal of a dominant dietary trigger may profoundly affect type 1 diabetes incidence. We present epidemiological, animal-based, in vitro and theoretical evidence for A1 ß-casein and its ß-casomorphin-7 derivative as dominant causal triggers of type 1 diabetes. The effects of ordinary milk containing A1 and A2 ß-casein and milk containing only the A2 ß-casein warrant comparison in prospective trials.
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Caseínas/efeitos adversos , Diabetes Mellitus Tipo 1/etiologia , Leite/efeitos adversos , Animais , Humanos , Fatores de RiscoRESUMO
OBJECTIVE: The aim of this study is to evaluate the impact of the Health-Promoting Communities: Being Active Eating Well (HPC:BAEW, 2007-2010) initiative, which comprised community-based multi-component interventions adapted to community context in five separate communities. The intervention aimed to promote healthy eating, physical activity and stronger, healthier communities. METHODS: A mixed method and multilevel quasi-experimental evaluation of the HPC:BAEW initiative captured process, impact and outcome data. The evaluation involved both cross-sectional (children and adolescents) and longitudinal designs (adults) with data collected pre- and post-intervention in intervention (n=2408 children and adolescents from 18 schools, n=501 adults from 22 workplaces) and comparison groups (n=3163 children and adolescents from 33 schools, n=318 adults from seven workplaces). Anthropometry, obesity-related behavioural and environmental data, information regarding community context and implementation factors were collected. The primary outcomes were differences in anthropometry (weight, waist, body mass index (BMI) and standardised BMI (BMI z-score)) over time compared with comparison communities. Baseline data was collected 2008/2009 and post-intervention collected in 2010 with an average intervention time frame of approximately 12 months. RESULTS: The strategies most commonly implemented were related to social marketing, stakeholder engagement, network and partnership development, community-directed needs assessment and capacity building. Analysis of post-intervention data showed gains in community capacity, but few impacts on environments, policy or individual knowledge, skills, beliefs and perceptions. Relative to the comparison group, one community achieved a lower prevalence of overweight/obesity, lower weight, waist circumference and BMI (P<0.005). One community achieved a higher level of healthy eating policy implementation in schools; two communities achieved improved healthy eating-related behaviours (P<0.03); one community achieved lower sedentary behaviours; and one community achieved higher levels of physical activity in schools (P<0.05). All effect sizes were in the small-to-moderate range. CONCLUSIONS: This was a complex and ambitious initiative, which attempted to expand a previously successful community-based intervention in Victoria into five new contexts and communities. Overall, project success was quite inconsistent, and some significant differences were in the unanticipated direction. However, there are many important learnings that should inform future health-promotion activities. The heterogeneity of outcomes of HPC:BAEW communities reflects the reality of life whereby effectiveness of intervention strategies is dependent on individual and community factors. Future health promotion should consider a systems approach whereby existing systems are modified rather than relying heavily on the addition of new activities, with longer time frames for implementation.
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Serviços de Saúde Comunitária , Dieta Saudável , Promoção da Saúde , Obesidade/prevenção & controle , Instituições Acadêmicas , Adolescente , Adulto , Criança , Estudos Transversais , Dieta , Exercício Físico , Feminino , Promoção da Saúde/métodos , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Prevalência , Avaliação de Programas e Projetos de Saúde , População Rural , População Urbana , VitóriaRESUMO
BACKGROUND: There is a paucity of studies evaluating targeted obesity prevention interventions in pre-school children. OBJECTIVES: We conducted a randomized controlled trial to evaluate the efficacy of a parent-based obesity prevention intervention for pre-schoolers - MEND (Mind, Exercise, Nutrition Do It!) 2-4 on child diet, eating habits, physical activity/sedentary behaviours, and body mass index (BMI). METHODS: Parent-child dyads attended 10 weekly 90-min workshops relating to nutrition, physical activity and behaviours, including guided active play and healthy snack time. Assessments were conducted at baseline, immediately post-intervention, and 6 and 12 months post-intervention; child intake of vegetables, fruit, beverages, processed snack foods, fussiness, satiety responsiveness, physical activity, sedentary behaviour and neophobia were assessed via parent proxy report. Parent and child height and weight were measured. RESULTS: Two hundred one parent-child dyads were randomized to intervention (n = 104) and control (n = 97). Baseline mean child age was 2.7 (standard deviation [SD] 0.6) years, and child BMI-for-age z-score (World Health Organization) was 0.66 (SD 0.88). We found significant positive group effects for vegetable (P = 0.01) and snack food (P = 0.03) intake, and satiety responsiveness (P = 0.047) immediately post-intervention. At 12 months follow-up, intervention children exhibited less neophobia (P = 0.03) than controls. CONCLUSION: Future research should focus on additional strategies to support parents to continue positive behaviour change. ACTRN12610000200088.
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Promoção da Saúde/organização & administração , Poder Familiar , Pais , Obesidade Infantil/prevenção & controle , Adolescente , Índice de Massa Corporal , Peso Corporal , Criança , Pré-Escolar , Dieta , Exercício Físico , Comportamento Alimentar/psicologia , Feminino , Frutas , Humanos , Masculino , Pais/psicologia , Avaliação de Programas e Projetos de Saúde , Instituições Acadêmicas , VerdurasRESUMO
Unhealthy diets represent one of the major risk factors for non-communicable diseases. There is currently a risk that the political influence of the food industry results in public health policies that do not adequately balance public and commercial interests. This paper aims to develop a framework for categorizing the corporate political activity of the food industry with respect to public health and proposes an approach to systematically identify and monitor it. The proposed framework includes six strategies used by the food industry to influence public health policies and outcomes: information and messaging; financial incentive; constituency building; legal; policy substitution; opposition fragmentation and destabilization. The corporate political activity of the food industry could be identified and monitored through publicly available data sourced from the industry itself, governments, the media and other sources. Steps for country-level monitoring include identification of key food industry actors and related sources of information, followed by systematic data collection and analysis of relevant documents, using the proposed framework as a basis for classification of results. The proposed monitoring approach should be pilot tested in different countries as part of efforts to increase the transparency and accountability of the food industry. This approach has the potential to help redress any imbalance of interests and thereby contribute to the prevention and control of non-communicable diseases.
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Comércio/legislação & jurisprudência , Indústria Alimentícia/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Obesidade/prevenção & controle , Saúde Pública , Conflito de Interesses , Humanos , Manobras Políticas , Comunicação Persuasiva , Formulação de Políticas , Política , Saúde Pública/legislação & jurisprudência , Medição de RiscoRESUMO
BACKGROUND/OBJECTIVES: To examine the relationship between diet quality and mental health in an ethnically diverse adolescent population in New Zealand. SUBJECTS/METHODS: Cross-sectional, population-based study design. Data were available at baseline for 4249 students. Responses from self-reported dietary questionnaires were used to assess diet quality; healthy eating and unhealthy eating were assessed as two separate scales. Mental health was assessed by the emotional subscale of the PedsQL instrument. RESULTS: Eating a healthy diet was significantly associated with better emotional health (P<0.001) and eating an unhealthy diet was significantly associated with greater emotional distress (P<0.001), after controlling for age, ethnicity and gender. The healthy and unhealthy eating scales were independently related to mental health scores. CONCLUSIONS: These findings contribute to a growing body of literature that diet quality is associated with mental health in adolescents. Further research is warranted to determine whether improvements to the diets of adolescents can have meaningful improvements to mental well-being.
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Dieta/psicologia , Etnicidade , Saúde Mental , Adolescente , Fenômenos Fisiológicos da Nutrição do Adolescente , Sintomas Afetivos , Criança , Estudos Transversais , Feminino , Qualidade dos Alimentos , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Nova Zelândia , Inquéritos e Questionários , Populações Vulneráveis , Adulto JovemRESUMO
BACKGROUND: Successful obesity prevention will require a leading role for governments, but internationally they have been slow to act. League tables of benchmark indicators of action can be a valuable advocacy and evaluation tool. OBJECTIVE: To develop a benchmarking tool for government action on obesity prevention, implement it across Australian jurisdictions and to publicly award the best and worst performers. DESIGN: A framework was developed which encompassed nine domains, reflecting best practice government action on obesity prevention: whole-of-government approaches; marketing restrictions; access to affordable, healthy food; school food and physical activity; food in public facilities; urban design and transport; leisure and local environments; health services, and; social marketing. A scoring system was used by non-government key informants to rate the performance of their government. National rankings were generated and the results were communicated to all Premiers/Chief Ministers, the media and the national obesity research and practice community. RESULTS: Evaluation of the initial tool in 2010 showed it to be feasible to implement and able to discriminate the better and worse performing governments. Evaluation of the rubric in 2011 confirmed this to be a robust and useful method. In relation to government action, the best performing governments were those with whole-of-government approaches, had extended common initiatives and demonstrated innovation and strong political will. CONCLUSION: This new benchmarking tool, the Obesity Action Award, has enabled identification of leading government action on obesity prevention and the key characteristics associated with their success. We recommend this tool for other multi-state/country comparisons.
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Benchmarking/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Promoção da Saúde/legislação & jurisprudência , Obesidade/prevenção & controle , Saúde Pública/legislação & jurisprudência , Austrália , Benchmarking/normas , Estudos de Viabilidade , Promoção da Saúde/normas , Humanos , Saúde Pública/normas , Marketing SocialRESUMO
BACKGROUND/OBJECTIVES: Body weight is negatively associated with adolescent Health-Related Quality of Life (HRQoL). Despite this well-established relationship, some adolescents with obesity do not display the expected HRQoL decreases. This study hypothesised weight perception as a moderator of the association between weight status and adolescent HRQoL. SUBJECTS/METHODS: Subjects were secondary school students from an obesity prevention project in the Barwon South-West region of Victoria, Australia, entitled It's Your Move (N=3040). Measures included standardised body mass index (BMI-z; World Health Organization growth standards), weight perception and HRQoL, measured by the Paediatric Quality of Life Inventory. Linear regression and average marginal effect analyses were conducted on cross-sectional baseline data to determine the significance of any interaction between weight perception and measured weight status in shaping adolescent HRQoL. RESULTS: The BMI-z/perceived weight status interaction was significantly associated with adolescent HRQoL outcomes. Adolescents with BMI z-scores in the overweight/obesity range who perceived themselves as overweight had lower HRQoL than those who perceived themselves as 'about right.' Conversely, adolescents with BMI scores in the lower end of the normal range or in the thinness range who perceived themselves as underweight had lower HRQoL than those with 'about right' perceptions. CONCLUSIONS: This was the first study to report third-variable impacts of a body-perception variable on the relationship between adolescent weight status and HRQoL. Adolescents' weight perceptions significantly moderated the relationship between overweight/obesity and reduced HRQoL. Adolescents who were outside the normal weight range and misperceived their objectively measured weight status enjoyed a higher HRQoL than adolescents whose weight perception was concordant with their actual weight status. These findings suggest that practitioners may need to exercise caution when educating adolescents about their weight status, as such 'reality checks' may negatively impact on adolescent HRQoL. It is suggested that more research be conducted to examine this potential effect.
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Comportamento do Adolescente/psicologia , Obesidade Infantil/psicologia , Percepção , Qualidade de Vida/psicologia , Adolescente , Austrália/epidemiologia , Imagem Corporal , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Masculino , Obesidade Infantil/epidemiologia , Obesidade Infantil/prevenção & controle , Assunção de Riscos , AutoimagemRESUMO
BACKGROUND: Depression and obesity are significant health concerns currently facing adolescents worldwide. This paper investigates the associations between obesity and related risk behaviours and depressive symptomatology in an Australian adolescent population. METHODS: Data from the Australian Capital Territory It's Your Move project, an Australian community-based intervention project were used. In 2012, 800 students (440 females, 360 males) aged 11-14â years (M=13.11â years, SD=0.62â years), from 6 secondary schools were weighed and measured and completed a questionnaire which included physical activity, sedentary behaviour and dietary intake. Weight status was defined by WHO criteria. A cut-off score ≥10 on the Short Mood and Feelings Questionnaire indicated symptomatic depression. Logistic regression was used to test associations. RESULTS: After controlling for potential confounders, results showed significantly higher odds of depressive symptomatology in males (OR=1.22, p<0.05) and females (OR=1.12, p<0.05) who exceeded guidelines for daily screen-time leisure sedentary activities. Higher odds of depressive symptoms were seen in females who consumed greater amounts of sweet drink (OR=1.18, p<0.05), compared to lower female consumers of sweet drinks, and males who were overweight/obese also had greater odds of depressive symptoms (OR=1.83, p<0.05) compared to male normal weight adolescents. CONCLUSIONS: This study demonstrates the associations between obesogenic risks and depression in adolescents. Further research should explore the direction of these associations and identify common determinants of obesity and depression. Mental health outcomes need to be included in the rationale and evaluation for diet and activity interventions.
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Obesidade Infantil/psicologia , Adolescente , Território da Capital Australiana , Criança , Estudos Transversais , Depressão/complicações , Feminino , Humanos , Masculino , Razão de Chances , Obesidade Infantil/prevenção & controle , Fatores de Risco , Distribuição por Sexo , Inquéritos e QuestionáriosRESUMO
BACKGROUND/OBJECTIVES: The most recent New Zealand Adult Nutrition Survey 2008/09 (ANS 08/9) revealed a decrease in reported energy intakes (EIs) compared with the previous 1997 National Nutrition Survey (NNS97). Conversely, measured body weights increased over the same period. We conducted an analysis on the ANS 08/9 data sets to evaluate reported EIs. SUBJECTS/METHODS: Analysis was conducted on data from 3919 (1715 men and 2204 women aged > or = 15 years) survey participants who completed the 24-h dietary recall in the ANS 08/9. Under-reporting was assessed using the ratio of reported EI to estimated resting metabolic rate (EI:RMRest), and a cutoff limit of <0.9 (EI:RMRest) was used to identify low energy reporters (LERs). Results were examined by gender, body size, age and ethnicity. RESULTS: The mean EI:RMRest (s.e.m.) was 1.34 (0.02) for men, and 1.23 (0.02) for women. Overall, 21% of men and 25% of women were classified as LERs. There was a greater prevalence of LERs among people with overweight (25%), or obesity (30%) than people with normal body weight (16%, P<0.001). The oldest age group (> or =65 years) had a greater prevalence of LERs (33%) compared with all other age groups (19-24%, P<0.001). Pacific people had a greater prevalence of LERs (33%) compared with Maori (26%, P=0.007) and European (23%, P<0.001). Compared with the NNS97, a substantial increase in the prevalence of LERs was evident in most subgroups. CONCLUSIONS: Under-reporting of EI will continue to be a major limitation of nutrition surveys without technological innovation. Care should be taken when interpreting EI data.
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Dieta , Inquéritos Nutricionais , Autorrelato , Adolescente , Adulto , Idoso , Metabolismo Basal , Índice de Massa Corporal , Tamanho Corporal , Ingestão de Energia , Etnicidade , Feminino , Humanos , Masculino , Memória de Curto Prazo , Pessoa de Meia-Idade , Nova Zelândia , Avaliação Nutricional , Obesidade , Sobrepeso , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To investigate the relationship between excess weight (overweight and obesity) and health-related quality of life (HRQoL) in a sample of secondary school children in Fiji, by gender, age and ethnicity. METHODS: The study comprised 8947 children from forms 3-6 (age 12-18 years) in 18 secondary schools on Viti Levu, the main island of Fiji. Body mass index (BMI) was calculated from measured height and weight, and weight status was classified according to the International Obesity Task Force recommendations. HRQoL was measured by the self-report version of the Pediatric Quality of Life Inventory 4.0. RESULTS: HRQoL was similar in children with obesity and normal weight. Generally, this was replicated when analyzed separately by gender and ethnicity, but age stratification revealed disparities. In 12-14-year-old children, obesity was associated with better HRQoL, owing to better social and school functioning and well-being, and in 15-18-year olds with poorer HRQoL, owing to worse physical, emotional and social functioning and well-being (Cohen's d 0.2-0.3). Children with a BMI in the overweight range also reported a slightly lower HRQoL than children with a BMI in the normal weight range, but although statistically significant, the size of this difference was trivial (Cohen's d <0.2). DISCUSSION: The results suggest that, overall there is no meaningful negative association between excess weight and HRQoL in secondary school children in Fiji. This is in contradiction to the negative relationship between excess weight and HRQoL shown in studies from other countries and cultures. The assumption that a large body size is associated with a lower quality of life cannot be held universally. Although a generally low HRQoL among children in Fiji may be masking or overriding the potential effect of excess weight on HRQoL, socio-economic and/or socio-cultural factors, may help to explain these relationships.
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Comportamento do Adolescente/psicologia , Sobrepeso/psicologia , Qualidade de Vida , Adolescente , Comportamento do Adolescente/etnologia , Composição Corporal , Índice de Massa Corporal , Criança , Estudos Transversais , Características Culturais , Feminino , Fiji/epidemiologia , Nível de Saúde , Humanos , Masculino , Sobrepeso/epidemiologia , Sobrepeso/etnologia , Aptidão Física , Instituições Acadêmicas , Autoimagem , Autorrelato , Fatores SocioeconômicosRESUMO
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: Childhood obesity has been increasing over decades and scalable, population-wide solutions are urgently needed to reverse this trend. Evidence is emerging that community-based approaches can reduce unhealthy weight gain in children. In some countries, such as Australia, the prevalence of childhood obesity appears to be flattening, suggesting that some population-wide changes may be underway. WHAT THIS STUDY ADDS: A community-based intervention project for obesity prevention in a rural town appears to have increasing effects 3 years after the end of the project, substantially reducing overweight and obesity by 6% points in new cohorts of children, 6 years after the original baseline. An apparent and unanticipated 'spillover' of effects into the surrounding region appeared to have occurred with 10%-point reductions in childhood overweight and obesity over the same time period. A 'viral-like' spread of obesity prevention efforts may be becoming possible and an increase in endogenous community activities appears to be surprisingly successful in reducing childhood obesity prevalence. BACKGROUND: The long-term evaluations of community-based childhood obesity prevention interventions are needed to determine their sustainability and scalability. OBJECTIVES: To measure the impacts of the successful Be Active Eat Well (BAEW) programme in Victoria, Australia (2003-2006), 3 years after the programme finished (2009). METHODS: A serial cross-sectional study of children in six intervention and 10 comparison primary schools in 2003 (n = 1674, response rate 47%) and 2009 (n = 1281, response rate 37%). Height, weight, lunch box audits, self-reported behaviours and economic investment in obesity prevention were measured. RESULTS: Compared with 2003, the 2009 prevalence of overweight/obesity (World Health Organization criteria) was significantly lower (P < 0.001) in both intervention (39.2% vs. 32.8%) and comparison (39.6% vs. 29.1%) areas, as was the mean standardized body mass index (0.79 vs. 0.65, 0.77 vs. 0.57, respectively) with no significant differences between areas. Some behaviours improved and a few deteriorated with any group differences favouring the comparison area. In 2009, the investment in obesity prevention in intervention schools was about 30 000 Australian dollars (AUD) per school per year, less than half the amount during BAEW. By contrast, the comparison schools increased from a very low base to over 66 000 AUD per school per year in 2009. CONCLUSIONS: The 8%-point reduction in overweight/obesity in both areas over 6 years from baseline to 3 years post-intervention was substantial. While the benefits of BAEW increased in the intervention community in the long term, the surrounding communities appeared to have more than caught up in programme investments and health gains, suggesting a possible 'viral spread' of obesity prevention actions across the wider region.
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Serviços de Saúde Comunitária , Obesidade Infantil/prevenção & controle , Adolescente , Antropometria , Austrália/epidemiologia , Índice de Massa Corporal , Criança , Estudos Transversais , Exercício Físico , Comportamento Alimentar , Feminino , Seguimentos , Comportamentos Relacionados com a Saúde , Promoção da Saúde , Humanos , Masculino , Prevalência , Instituições AcadêmicasRESUMO
BACKGROUND: Many studies examining population differences in soft drink consumption or the association it has with fatness have not included serving size in its assessment. It is not clear what effect this has on their findings and our study aimed to investigate this by comparing the relationships that days (serving size unaccounted for) and cans/day (serving size accounted for) of consumption have with ethnicity/country and fatness. METHODS: Daily nutrient intakes were calculated from a self-administered food frequency questionnaire from a cross-sectional health screening study. Participants were Pacific (n=954) and New Zealand European (n=1745) people aged 35 to 74 years. RESULTS: Compared to Australian youth, NZ Pacific youth consumed soft drinks more frequently but a larger difference was observed for cans/day. In a dose-dependent manner, FMI was positively associated with days (P=0.015) and cans/day (P=0.024) of consumption. However, cans/day showed a stronger relationship, with a standardised regression coefficient of 0.066, compared to 0.033 for days of consumption. CONCLUSIONS: It is useful to include serving size in the assessment of soft drink consumption. Excluding it leads to underestimation of both ethnic/country differences in daily volume of intake and associations with fatness.
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Bebidas Gaseificadas , Tamanho da Porção , Adolescente , Austrália/epidemiologia , Estudos Transversais , Ingestão de Energia , Feminino , Humanos , Masculino , Havaiano Nativo ou Outro Ilhéu do Pacífico , Nova Zelândia/epidemiologia , Obesidade/epidemiologia , Obesidade/prevenção & controle , Inquéritos e Questionários , População Branca , Adulto JovemRESUMO
The International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support (INFORMAS) proposes to collect performance indicators on food policies, actions and environments related to obesity and non-communicable diseases. This paper reviews existing communications strategies used for performance indicators and proposes the approach to be taken for INFORMAS. Twenty-seven scoring and rating tools were identified in various fields of public health including alcohol, tobacco, physical activity, infant feeding and food environments. These were compared based on the types of indicators used and how they were quantified, scoring methods, presentation and the communication and reporting strategies used. There are several implications of these analyses for INFORMAS: the ratings/benchmarking approach is very commonly used, presumably because it is an effective way to communicate progress and stimulate action, although this has not been formally evaluated; the tools used must be trustworthy, pragmatic and policy-relevant; multiple channels of communication will be needed; communications need to be tailored and targeted to decision-makers; data and methods should be freely accessible. The proposed communications strategy for INFORMAS has been built around these lessons to ensure that INFORMAS's outputs have the greatest chance of being used to improve food environments.
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Dieta , Política de Saúde , Promoção da Saúde/organização & administração , Política Nutricional , Obesidade/prevenção & controle , Saúde Pública , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/prevenção & controle , Comunicação , Exercício Físico , Comportamento Alimentar , Feminino , Serviços de Alimentação , Humanos , Lactente , Alimentos Infantis/normas , Masculino , Obesidade/epidemiologia , Fatores Socioeconômicos , Uso de Tabaco/epidemiologia , Uso de Tabaco/prevenção & controleRESUMO
Non-communicable diseases (NCDs) dominate disease burdens globally and poor nutrition increasingly contributes to this global burden. Comprehensive monitoring of food environments, and evaluation of the impact of public and private sector policies on food environments is needed to strengthen accountability systems to reduce NCDs. The International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) is a global network of public-interest organizations and researchers that aims to monitor, benchmark and support public and private sector actions to create healthy food environments and reduce obesity, NCDs and their related inequalities. The INFORMAS framework includes two 'process' modules, that monitor the policies and actions of the public and private sectors, seven 'impact' modules that monitor the key characteristics of food environments and three 'outcome' modules that monitor dietary quality, risk factors and NCD morbidity and mortality. Monitoring frameworks and indicators have been developed for 10 modules to provide consistency, but allowing for stepwise approaches ('minimal', 'expanded', 'optimal') to data collection and analysis. INFORMAS data will enable benchmarking of food environments between countries, and monitoring of progress over time within countries. Through monitoring and benchmarking, INFORMAS will strengthen the accountability systems needed to help reduce the burden of obesity, NCDs and their related inequalities.
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Dieta , Obesidade/prevenção & controle , Saúde Pública , Benchmarking , Feminino , Política de Saúde , Promoção da Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Cooperação Internacional , Masculino , Obesidade/epidemiologia , Garantia da Qualidade dos Cuidados de Saúde , Fatores SocioeconômicosRESUMO
Government action is essential to increase the healthiness of food environments and reduce obesity, diet-related non-communicable diseases (NCDs), and their related inequalities. This paper proposes a monitoring framework to assess government policies and actions for creating healthy food environments. Recommendations from relevant authoritative organizations and expert advisory groups for reducing obesity and NCDs were examined, and pertinent components were incorporated into a comprehensive framework for monitoring government policies and actions. A Government Healthy Food Environment Policy Index (Food-EPI) was developed, which comprises a 'policy' component with seven domains on specific aspects of food environments, and an 'infrastructure support' component with seven domains to strengthen systems to prevent obesity and NCDs. These were revised through a week-long consultation process with international experts. Examples of good practice statements are proposed within each domain, and these will evolve into benchmarks established by governments at the forefront of creating and implementing food policies for good health. A rating process is proposed to assess a government's level of policy implementation towards good practice. The Food-EPI will be pre-tested and piloted in countries of varying size and income levels. The benchmarking of government policy implementation has the potential to catalyse greater action to reduce obesity and NCDs.
Assuntos
Programas Governamentais/organização & administração , Política de Saúde , Promoção da Saúde/organização & administração , Política Nutricional , Obesidade/prevenção & controle , Formulação de Políticas , Benchmarking , Dieta , Exercício Físico , Feminino , Indústria Alimentícia , Serviços de Alimentação , Política de Saúde/legislação & jurisprudência , Promoção da Saúde/legislação & jurisprudência , Humanos , Cooperação Internacional , Masculino , Política Nutricional/legislação & jurisprudência , Obesidade/epidemiologia , Fatores SocioeconômicosRESUMO
Private-sector organizations play a critical role in shaping the food environments of individuals and populations. However, there is currently very limited independent monitoring of private-sector actions related to food environments. This paper reviews previous efforts to monitor the private sector in this area, and outlines a proposed approach to monitor private-sector policies and practices related to food environments, and their influence on obesity and non-communicable disease (NCD) prevention. A step-wise approach to data collection is recommended, in which the first ('minimal') step is the collation of publicly available food and nutrition-related policies of selected private-sector organizations. The second ('expanded') step assesses the nutritional composition of each organization's products, their promotions to children, their labelling practices, and the accessibility, availability and affordability of their products. The third ('optimal') step includes data on other commercial activities that may influence food environments, such as political lobbying and corporate philanthropy. The proposed approach will be further developed and piloted in countries of varying size and income levels. There is potential for this approach to enable national and international benchmarking of private-sector policies and practices, and to inform efforts to hold the private sector to account for their role in obesity and NCD prevention.